Do I Need an X-Ray or MRI for Lower Back Pain? A Chiropractor’s Honest Answer

Greg Conlan No Comments , , , , , Back Pain, Chiropractic Care, imaging back pain, Spine Health

Do I Need an X-Ray or MRI for Lower Back Pain? A Chiropractor’s Honest Answer

Most people with lower back pain do not need an X-ray or MRI.

Scans are only helpful when specific red flags are present or when symptoms don’t improve with appropriate care.

Do I need an X-ray or MRI for my lower back pain?do I need an x-ray or MRI for lower back pain

In most cases, no.
 Scans rarely change the treatment plan for everyday lower back pain.

This surprises most people.
 But decades of research show imaging is often unnecessary for common back pain.

Why?

Because most back pain is:

  • Mechanical - has to do with your back joints structure
  • Functional -  has to do with how your back joints move
  • Related to movement patterns - leveraged bends and twists, prolonged sitting
  • Not caused by serious structural damage

Why do doctors and chiropractors avoid scanning most back pain?

Scans are very good at finding abnormalities.
 However, they are not very good at finding the cause of pain.

Imaging frequently shows:

  • Disc bulges
  • Disc degeneration
  • Arthritis
  • “Wear and tear”
  • Minor alignment variations

These changes are:

  • Extremely common
  • Normal with age
  • Often painless

Many people with no pain at all have these findings. Indeed, if you were to take a scan the day before your pain onset it is most likely your scan would look precisely the same.

Key point:
 Seeing changes on a scan doesn’t mean they are causing your pain.

What is Causing my lower back pain? What “normal age-related changes” actually mean.

This phrase confuses and worries patients.

Normal age-related spinal changes include:

  • Disc dehydration
  • Reduced disc height
  • Mild arthritic changes
  • Small disc bulges

These are similar to:

  • Wrinkles on your skin
  • Grey hair
  • Reduced flexibility with age

They are not injuries.
 They are part of living in a body and so we expect reasonable degrees of degenerative change commensurate with your age.

Yet once someone sees these words on a report, fear often follows.

Fear leads to:

  • Avoiding movement
  • Over-protecting the back
  • Reduced activity
  • More pain over time

Key point:
 Viewing your  scans can increase pain by increasing fear.

When is imaging actually helpful for lower back pain?

Scans are useful when specific red flags exist.

These include:

  • Severe trauma - such as a ladder fall or motor vehicle accident
  • Progressive weakness in the leg and loss of control
  • Loss of bowel or bladder control - unexplained incontinence
  • Unexplained significant weight loss
  • Fever with back pain
  • Night pain that doesn’t change with movement
  • Suspicion of fracture, infection, or cancer
  • Prolonged cortisone use - such as for rheumatoid arthritis, lung disease, multiple sclerosis and organ transplantation.

In these cases, imaging helps rule out serious pathology.

Key point:
 Scans are for ruling out serious problems, not explaining everyday pain.

Why do people feel better after getting a scan?

Reassurance feels powerful.
 Seeing something “explains” the pain emotionally.

But reassurance can backfire if the scan:

  • Shows disc bulges or uses words you associate with severe pain
  • Shows arthritis and damage that you did not expect or understand as normal
  • Uses scary language - bulge, prolapse and degeneration are common ones

Patients often hear:

“My back is damaged.”
 “I have degeneration.”
 “My spine is worn out.”

This creates:

  • Fear of movement
  • Fear of lifting
  • Fear of exercise
  • Long-term pain behaviour

The scan didn’t help recovery.
 It changed beliefs about the back.

Key point:
 What you believe about your back strongly affects how it recovers.

Do I Need and x-ray or MRI for Lower Back Pain?  Can scans miss the real cause of my pain?

Yes.
 Scans show structure, not function. It's like a motor car you are considering buying. The car might look just fine but until you drive it you know very little about it. It may not even start let alone perform.

They cannot show:

  • Muscle coordination
  • Joint stiffness
  • Load tolerance
  • Movement habits
  • Nervous system sensitivity

Your pain may be coming from how your spine moves, not what it looks like.

Key point:
 Movement quality matters more than what an image shows.

What does a chiropractor assess that a scan can’t show?

A clinical assessment looks at how your back behaves in real life.

We assess:

  • Range of motion
  • Pain patterns
  • Joint mobility
  • Muscle activation
  • Functional movement
  • Load response

This tells us:

  • What’s overloaded
  • What’s underperforming
  • What movements need restoring
  • What tissues need calming

Key point:
 Function explains pain better than pictures.

What if I’ve already had a scan that shows disc bulges or arthritis?

This is very common.
 It does not mean your back is “broken.”

Important realities:

  • Disc bulges often heal or adapt
  • Arthritis does not equal pain
  • Degeneration does not equal disability

Your spine adapts to load.
 Your nervous system adapts to movement.

With the right care plan, people with “bad-looking” scans:

  • Return to sport
  • Return to work
  • Return to lifting
  • Return to trusting their back

Key point:
 Your scan does not define your future.

Will an MRI change my treatment plan?

Usually, no.
 Your care plan is based on:

  • Symptoms
  • Function
  • Movement tolerance
  • Progress over time

Imaging is only needed if:

  • Symptoms worsen unexpectedly
  • Neurological signs progress
  • You fail to improve with appropriate care
  • Surgery is being considered

Key point:
 Treatment follows your response, not your scan report.

What should I do instead of rushing into a scan?

Start with:

  • A thorough clinical assessment
  • Targeted manual therapy
  • Gradual movement restoration
  • Load management strategies
  • Simple home exercises

Monitor response over 2–6 weeks.

Most back pain improves when:

  • Movement returns
  • Fear reduces
  • Strength and control improve

Key point:
 The right care early reduces the need for scans later.

FAQ

Do I need an MRI for lower back pain?

Most people with lower back pain do not need an MRI. Imaging is only recommended when red flags are present, symptoms worsen, or recovery does not occur with appropriate care. MRIs often show normal age-related changes that are not the source of pain.

Can an X-ray show what’s causing my back pain?

X-rays show bone structure, not muscles, discs, or nerves. They rarely explain the cause of mechanical back pain. X-rays are mainly useful for ruling out fractures, major joint disease, or structural abnormalities after trauma.

Will a scan help me recover faster?

Not usually. Scans rarely change treatment plans for everyday back pain. Recovery is driven by restoring movement, improving load tolerance, and calming the nervous system—not by imaging results.

Why do scans make people more worried about their back?

Scan reports often use terms like “degeneration” or “disc bulge,” which sound serious but are common and often painless. These labels can increase fear of movement, which slows recovery and increases pain sensitivity.

When should imaging be considered for back pain?

Imaging is appropriate when there are red flags such as severe trauma, progressive weakness, loss of bladder or bowel control, unexplained weight loss, fever, or persistent night pain that doesn’t change with movement.

One Clear Action

Book a spinal assessment at Northcote Chiropractic Centre or Essendon Health & Sports Centre to determine whether imaging is actually necessary for your back pain.